Tubman 

Co-Occuring Disorders Case Management Internship

by  Nan Watts

The Big Picture 


I spent the summer of 2022 interning as a clinical case manager at Minneapolis’ Tubman Chrysalis Center, working closely with staff and patients to meet mental and chemical health needs of low-income Twin Cities residents. A key motivating factor to work with Tubman was my awareness that despite its status as a first world country, the United States is well known for its insufficient public health services and programs[1]. There is a shortage of mental health professionals, frequent budget cuts to government programs, and a lack of attention paid to health equity. In a 2021 study which compared the performance of health care systems of 11 high-income countries, the United States ranked last on access to care, administrative efficiency, equity, and health care outcomes[2]. The issues of access coupled with the lack of equity in the American healthcare system has led to an insufficient number of public health programs and drastically different levels of quality of care depending on a person’s demographics. In response to discrepancies of quality care, community health focused nonprofit organizations will provide affordable services to help fill the vacuum. While nonprofits organizations are not an adequate solution to the government providing comprehensive care to its citizens, these organizations are necessary and provide insight into current trends in community health needs.


The COVID-19 pandemic added yet more barriers to access healthcare for community members, not to mention straining the existing health system to its limits. Working with an organization like Tubman whose goal is to provide/connect clients with affordable services, support, and information in the midst of a pandemic only further highlighted the environmental and social factors of public health which have fallen to the wayside. For example, substance use disorder remains stigmatized and some of the most common addiction programs use spirituality as a motivating factor, which often isn't ideal. In my time as a case manager, I quickly learnt that domestic violence programs and emergency housing shelters are underfunded and over capacity.  Non-profit organizations like Tubman provide trauma-informed care and resources to support community members who would otherwise “slip through the cracks” of the current healthcare system, especially given how overwhelmed the health system had been due to the pandemic. Resultantly, it was of utmost importance during my time as a case manager to identify and understand Tubman’s most in-demand services, inter-organizational challenges, and clients’ most common barriers to care.


Who is Tubman?

Tubman is a 501(c)3 nonprofit multi-service organization that helps people who have experienced relationship violence, homelessness, mental and chemical health challenges, and other trauma find safety and healing. The Tubman organization provides a wide array of services including safe shelter, legal services, mental and chemical health counseling, youth programming, and community education.

Tubman, now almost fifty years old, helps roughly 20,000 people each year in the Twin Cities find programs, support, and information. Tubman was formed from the union of four organizations. In 2001, the Harriet Tubman Center, a domestic violence shelter, and Family Violence Network merged to form the Tubman Family Alliance[3]. In 2007, Chrysalis, A Center for Women, joined the alliance and then in 2011, ElderCare Rights Alliance also joined. The Harriet Tubman center originally opened as the third battered women’s shelter in the county, continually expanding its support services as organizational alliances formed.


Today, Tubman has two main locations - Tubman Chrysalis Center and Harriet Tubman Center East, as well as a 24-hour crisis and resource hotline. Services offered at Tubman fall into six main camps: safety planning and resources, shelter and housing, legal help, mental and chemical health services, youth programs, and community support services. Programs that are directly offered at/by Tubman include legal services, mental and chemical clinical services, shelter and housing services, and youth development services. Individuals seeking services that are not directly offered by Tubman are referred to partnered organizations. By collaborating with other local organizations, the range of services that an individual can find simply by reaching out to Tubman are innumerable.

My Work at Tubman

I worked directly with Tubman’s clinical services team over the summer of 2022. Within clinical services there are designated staff for both mental and chemical health, as well as a director of clinical services. In total, there are roughly 20 clinical services staff leading therapy programs, conducting case management, holding individual therapy sessions, medication management, and health assessments. Because of the direct patient care and community engagement required in a case management position, I underwent several weeks of site-specific training before integrating with the clinical staff. After completing the requisite training, my work was hybridized to best suit patient needs.


  I maintained a caseload of roughly 5-7 clients enrolled in Tubman’s co-occurring disorders program, meaning the patients had both mental health concerns and substance use disorder. With supervision, I developed and maintained individual care plans, advocated on behalf of clients with external organizations, and worked closely with staff to facilitate case coordination.

I would join the clinical staff at the Chrysalis Center two and three times a week for group therapy sessions, in-person meetings with patients, and staff meetings. I did the other part of my work remotely, spending the rest of the weekdays researching specific resources and programs for individual clients, speaking with other healthcare providers and organizations about active referrals and intakes, and compiling a database of up-to-date resources for other Tubman staff.

Lessons Learned

In my four months as a case manager, there were several recurring themes in terms of patient needs, organizational needs, and which clinical services were most needed. My co-occurring disorders patients continually reported that the isolation brought on by the pandemic only worsened their health issues and substance use. Additionally, low-cost transportation services and childcare, which made attending mental health programs more feasible, often had reduced capacity. Patients commonly reported wanting to get better but felt unable to attend necessary treatment programs due to time conflicts and inaccessibility. Tubman staff discussed how the national shortage of mental health professionals was impacting the kinds of services they could offer at any given time, as some forms of group therapy require therapists to have multiple forms of licensure.Between the barriers clients face and the challenges Tubman has, group therapy sessions were often underpopulated, and several programs couldn’t be offered at all. This reaffirmed to me that the challenges to providing comprehensive, trauma-informed services were coming from all sides, and that public health agencies such as state health departments must invest in accessibility as they do programming. 

References

[1] Council, R., US), M., Woolf, S. H., & Aron, L. (2013). Public Health and Medical Care Systems. Nih.gov; National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK154484/

[2] Mirror, Mirror 2021: Reflecting Poorly. (2021). Commonwealthfund.org. https://doi.org/10.26099/01dv-h208

[3] Mission & History : Who We Are : Tubman. (2023). Tubman.org. https://www.tubman.org/who-we-are/mission.html


Nan Watts 

My name is Nan Watts and I’m originally from San Francisco, California. I am an anthropology major with a community and global health concentration, with minors in biology and women, gender, and sexuality studies. During my time at Macalester, I developed a passion for studying healthcare at the community level and the role of health communications. I am a member of Macalester’s Friends of MSF student chapter, a proud organizing committee member of a unionized Starbucks, and an avocational oil painter. After graduation I plan to stay in the Twin Cities to continue working in public health at the community level.

Image Credits (in order of appearance):

‌Double, M. (2021, January 5). Bipolar disorder, mood change, mental illness, psychological... IStock.https://www.istockphoto.com/vector/metaphor-bipolar-disorder-mind-mental-double-face-split-personality-concept-mood-gm1294477039-388461111

Home : Tubman. (2023). Tubman.org. https://www.tubman.org/

DCCH Center for Children and Families. (2023). Dcchcenter.org. https://www.dcchcenter.org/what-we-do/targeted-case-management